Public Health Department seeks 30 new staffers

By Andy Metzger, State House News Service

Updated:
03/01/2013 08:32:35 AM EST

FITCHBURG -- The past year put in sharp focus the inadequacy of some areas of the Department of Public Health's regulatory and oversight abilities, and Interim Commissioner of Public Health Lauren Smith said Thursday that when she arrived -- after a deadly meningitis outbreak and the closure of a crime lab -- she engaged in a "frank and brutally honest introspection" with her staff.

One result of the introspection is a proposed $32 million budget increase at DPH, bringing the total amount to $549 million, which would allow for increased inspections and oversight of health care, hazardous-material and substance-abuse facilities. That would fund 30 new positions and send $1 million to the Board of Registration in Pharmacy, Smith said.

"The public in general goes through its business, its daily life and appropriately assumes that the services, the restaurants, the beaches, the mammography machines, or everywhere it goes, that someone has looked at that, and someone has made sure that it's OK," said Smith. "Our role, as I see it, is to make sure that the public's assumption that those things are well taken care of is actually true."

The public's confidence in pharmacies was shaken last year as hundreds fell ill around the country with ailments including fungal meningitis, from tainted steroids produced at the New England Compounding Center in Framingham.

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That outbreak, which has sickened 714 and killed 48 as of this week, led to reforms within DPH, including unannounced inspections at the state's 40 sterile compounding pharmacies, revealing that the alleged lack of proper protocols at NECC was not unique.

"Although NECC, their actions might have been the most egregious, clearly there is a necessity to have improved oversight of this industry," Smith told the House and Senate Ways and Means committees, which met at the Dukakis Performing Arts Center in Fitchburg on Thursday.

"It's going to be important for us to have those resources to investigate them," said Health and Human Services Secretary John Polanowicz in his own testimony. Of the other labs, Polanowicz said, "What we did find was only very few of them got a completely clean bill of health."

Gov. Deval Patrick's budget is predicated on tax reforms that would raise $1.9 billion in additional revenue by closing tax incentives, raising the income tax from 5.25 percent to 6.25 percent and lowering the sales tax from 6.25 percent to 4.5 percent.

Patrick's tax plan calls for a $1 increase on the cigarette tax and raised taxes on other tobacco products, which would raise roughly $69 million in fiscal 2014 and $166 million in fiscal 2015, Smith said. Applying the sales tax to candy and soda - items that are currently exempt, as is all other food -- would raise $22 million in fiscal 2014 and $53 million in fiscal 2015, while also accomplishing the goal of increasing the expense of unhealthy products, Smith said.

"Tobacco is the number one cause of preventable death in the commonwealth, and right now smoking related illnesses cost the Commonwealth $3.9 billion in health care expenses every year. In other words, that's about 1 percent of the state's gross domestic product," Smith said. She said, "As a mother and a pediatrician, I have to say, I am intermittently both appalled and frustrated and angered by the fact that the tobacco companies... are specifically marketing to your children and mine other tobacco products, and they do this through both attractive packaging, with fruit and candy flavored cigars, as well as price."

Smith held up chocolate, blueberry, cherry and white grape individually wrapped 79-cent cigars and a $1.50 pack of grape flavored cigarillos that she bought about a mile from her home and said are "clearly marketed towards youth."

Three quarters of adult smokers started using tobacco when they were youths, Smith said. She said more than half of the state's adults and almost one third of its high school and middle school students are overweight or obese.

The success or failure of Patrick's tax plans will affect whether proposed increases in spending on public health and other state budget accounts will take hold when the new fiscal year begins on July 1.

Former DPH Commissioner John Auerbach resigned in the wake of a criminal investigation and the closure of the Hinton crime lab, which was under DPH control when "rogue chemist" Annie Dookhan allegedly doctored drug evidence there.

"What happened there?" asked Rep. Viriato deMacedo (R-Plymouth).

"Those overall investigations are obviously still ongoing," Smith responded. While the drug lab is still shuttered and under control of the Executive Office of Public Safety and Security, the other Hinton labs, which test among other things "suspicious white powder" and potentially dangerous diseases, is high-quality, Smith said.

In addition to reforms and staffing increases, DPH will head into fiscal 2014 with the new charge of regulating medical marijuana, which voters in November made legal with a doctor's note starting Jan. 1.

"We're fortunate that we're not the first ones that are doing this, so we can look at both best practices and also things we want to avoid," Smith told the News Service. She said the department completed its third listening session on Wednesday and DPH would try to have its regulations written as close to the ballot initiative's May 1 deadline as possible.

The regulations will involve controls so marijuana would not be diverted away from patients, consideration of how much marijuana patients are permitted to have, and licensure of treatment centers, but DPH's work will extend beyond that.

"The regulations are really important and it's what we're working on, but there's the whole operations side of overseeing a brand new industry, that's sort of flicking a switch and being present," Smith said. She said, "We have to have IT systems that can keep track of all the information that you would want us to keep track of," while protecting privacy and making it accessible to law enforcement.

The funding increase would boost the number of inspectors in the Bureau of Health Care Safety and Quality, the Bureau of Environmental Health, and the Bureau of Substance Abuse Services. Those bureaus oversee biotech waste, radiation, food inspection, indoor air quality, residential drug abuse programs and lead exposure, Smith said.

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